Healthcare Provider Details

I. General information

NPI: 1790207884
Provider Name (Legal Business Name): BRIELLE ELIZABETH KADRMAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/21/2022
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N LAVENTURE RD STE A
MOUNT VERNON WA
98273-3901
US

IV. Provider business mailing address

11711 NE 12TH ST STE 3A
BELLEVUE WA
98005-2461
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-2700
  • Fax: 360-428-2701
Mailing address:
  • Phone: 425-450-9474
  • Fax: 425-452-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60740907
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: